General Purpose: To bring together California healthcare professionals, lay persons, medical ethicists, lawyers and members of the judiciary for the purpose of exploring the possibilities of developing institutional end-of-life medical treatment policies that will serve as a basis for standards of practice when conflicts occur. Planning Process: On January 23,1996, UCSD School of Medicine sponsored a conference involving the ethics committees of all the University of California hospitals in order to explore approaches to resolving problems raised by demands for treatments deemed medically futile by healthcare providers. This proposal is for a follow-up conference. In the six month period prior to this proposed conference, participants will provide selected readings to the other participants as background to this conference. In addition, they will arrange to have the participating institutions provide and circulate to all the other participants copies of their institutional policies dealing with these issues. Thus, all the participants will have an opportunity to prepare their responses to a common set of background materials. In addition, the institutions will have time to review other institutional policies and perhaps modify their own. Agenda and Specific Topics: The participants will address the following agenda and specific topics: (1) How can hospital policies provide guidance to physicians facing decisions to attempt or forgo life-sustaining treatment, including mechanical ventilation, tube feeding, and cardiopulmonary resuscitation in the absence of a request or agreement by a decisionally-capacitated patient/surrogate? (2) What conflict resolution procedures would be likely to satisfy the courts when disputes occur about treatment plans among healthcare providers and patients/families. (3) How can hospital policies provide guidance to physicians when decision-making involves patients from varying cultural and religious backgrounds who express varying attitudes towards life-sustaining treatment? (4) Can a consensus be reached that might serve as standards of care in resolving disputes over life-sustaining treatments? Format: For each subject area, one or a few exemplary cases will be presented. Speakers will then address the audience under the title: "How l See This Case." Speakers will include a physician, nurse, medical ethicist, lawyer, community representative and judge. Relevant portions of hospital policies will be cited, compared and critiqued with respect to their capacity to deal with these areas. Expected product: The proceedings of the conference will be transcribed and offered for publication in a medical and law journal for dissemination to those beyond the immediate audience. Although participants will be limited to the State of California (in order to limit costs), the observations and conclusions will be of national relevance.